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Stomach and Intestine(Tokyo) Volume 39, Issue 13 （December 2004）

胃と腸 39巻13号（2004年12月発行）

Japanese English

今月の主題大腸sm癌の内視鏡治療後の長期経過

主題

大腸sm癌内視鏡治療後の再発・転移の時期と再発様式について Recurrence after Endoscopic Resection of Submucosal Invasive Colorectal Cancer 井上雄志 ¹ , 手塚徹 ¹ , 篠原知明 ¹ , 斉田真 ¹ , 伊藤真史 ¹ , 市場洋 ¹ , 長廻紘 ¹ , 大井至 ¹ , 高崎健 ¹ Yuji Inoue ¹ , Toru Tezuka ¹ , Tomoaki Shinohara ¹ , Makoto Saida ¹ , Masashi Ito ¹ ¹東京女子医科大学消化器病センター ¹Institute of Gastroenterology, Tokyo Women's Medical University キーワード：大腸sm癌 , 内視鏡摘除術 , 局所再発 , リンパ節再発 , 血行性転移再発 Keyword: 大腸sm癌 , 内視鏡摘除術 , 局所再発 , リンパ節再発 , 血行性転移再発 pp.1719-1729

発行日 2004年12月25日 Published Date 2004/12/25

DOI https://doi.org/10.11477/mf.1403100596

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要旨　大腸sm癌内視鏡治療後再発を認めた7例（局所再発およびリンパ節再発4例，血行性転移再発3例）を検討した．（1）局所再発およびリンパ節再発4例：再発様式は局所再発のみが2例，リンパ節再発のみが1例，おのおのの重複が1例で，転移時期は4～48か月（平均20.3か月）であった．局所再発の2例に再度内視鏡摘除術，リンパ節再発の1例に経仙骨的腫瘍切除術，おのおのが重複した1例にリンパ節郭清を含めた腸管切除術を行い，いずれも治癒的切除が行いえた．（2）血行性転移再発3例：再発様式は肝再発のみが2例，肝・肺・骨多発転移が1例で，転移時期は6～60か月（平均25.3か月）であった．3例中2例は内視鏡摘除後追加腸切除を行っており，肝再発のみの2例に治癒的肝切除を行いえた．内視鏡治療後大腸sm癌の経過観察は厳重に行い，局所・リンパ節再発の診断には大腸内視鏡検査による局所の観察，特に瘢痕部の粘膜下腫瘍様所見に注意すべきで，分割摘除例はより厳重な経過観察が必要である．血行性転移再発の予測は困難であることが少なくないが，血行性転移再発の存在を念頭に置き，定期的に血中CEAの測定あるいは腹部超音波検査などの検索を行うべきと考えられた．

　We analyzed 7 cases of recurrence after endoscopic resection of submucosal invasive colorectal cancer.

　1 ) Local and lymph node recurrence

　Two patients had local recurrence, 1 patient had local and lymph node recurrence and 1 patient had lymph node recurrence. The recurrence occurred 4～48 months (mean 20.3 months) after endoscopic resection. Two patients who had local recurrence were able to undergo endoscopic resection again, 1 patient who had local and lymph node recurrence underwent surgical bowel resection, and 1 patient who had lymph node recurrence underwent transsacral tumor resection. Curative resection was accomplished in all 4 patients.

　2 ) Distant metastasis

　Two patients had liver metastasis and 1 patient had liver, lung and bone multiple metastases. The recurrence occurred 6～60 months (mean 25.3 months) after endoscopic resection. Two of 3 patients underwent additional surgical bowel resection after endoscopic resection, and 2 patients who had liver metastasis alone were able to receive curative hepatic resection.

　Therefore, it is important to resect the recurrence of submucosal invasive colorectal cancer early by careful follow-up. It is important to observe the scar of endoscopic resection, particularly we should pay attention to findings like submucosal tumor for diagnosing local and lymph node recurrence by colonoscopy, and it is necessary for patients who have undergone endoscopic piecemeal resection to be followed up carefully. It is often difficult to predict distant metastasis, so the measurement of serum CEA and abdominal ultrasonograghy should be performed.

　1) Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo